Provider Demographics
NPI:1447467790
Name:YENNI, JACQUELINE ANNETTA (MA, PLMHP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANNETTA
Last Name:YENNI
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5269
Mailing Address - Country:US
Mailing Address - Phone:308-534-8416
Mailing Address - Fax:308-534-8416
Practice Address - Street 1:108 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5430
Practice Address - Country:US
Practice Address - Phone:308-534-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025470100Medicaid